Transcript: The Lie That Heals: Should Doctors Give Placebos?

A controversial paper was recently published arguing that it's not only OK for doctors to lie to patients, but that we have a duty to deceive. Unlike what you see on television, roughly half the time a patient walks into a doctor's office, a firm diagnosis cannot be made. Half the time the doctor doesn't know what's going on. So why not give the patient a sugar pill, a homeopathic remedy—which is often just that, an actual sugar pill, or a flower remedy, whatever it takes. Just because they don't work better than placebo, doesn't mean they don't work. Certainly safer than prescribing an actual drug. "For a thousand years the action of the placebo has made vast numbers of patients feel better" so why stop now?

Even just offering a made-up diagnosis and false reassurance seems to work. 200 patients for whom no definite diagnosis could be made were randomized into two groups. The honesty group was told I don't know what's wrong with you, and the dishonesty group was given some fake but firm diagnosis and told confidently they'd get better in a few days—and guess what, they did. They were 90% more likely to be cured. A deception flowchart has even been devised to help doctors decide, for example, if they should consider lying versus a non-lying deception to meet objectives.

Those on the pro-truth side of the fence argue that first of all, placebos aren't necessarily always safe. The sugar in the sugar pills is typically lactose, milk sugar, for which most of humanity is intolerant after infancy. There was a famous cancer drug trial in which the chemotherapy caused a surprising reduction in nausea and vomiting compared to placebo, but that may have been because it was compared to a placebo made out of lactose.

Pro-truth advocates accuse doctors of disease-mongering. By defining vague symptoms as an entity requiring a treatment, healthy people are converted into patients. They need explanation and reassurance that promote autonomy, not to be given faith in a non-existent disease and crackpot medicine." In fact, they say, “hey, if all you care about is beneficial medical consequences, might not doctors also have a duty to prescribe things like chanting, crystals, and séances?” To which deception advocates reply, “Look, doctors have a duty to do the best they can to relieve a patient’s symptoms. If that means they prescribe a placebo, or even conduct a séance, then there is a duty to do these things. If a doctor can really convince a patient that a chant will cure his headache, then it very likely will, and she should chant like crazy.” In fact, "It is a type of deception that patients ought to be thankful for, just as we are thankful when we receive a mendacious compliment from a friend. Of course you don't look fat in that dress.

So how many doctors lie to their patients? About half, of surveyed internal medicine doctors and rheumatologists in the United States report prescribing placebo treatments on a regular basis. Similar numbers have been found in Canada, Europe, Israel, and New Zealand.

"Prescribing placebo treatments seems to be common and is viewed as ethically permissible. It's ironic that physicians often condemn alternative medicine quacks for giving useless remedies when they themselves do the same thing. As one physician commented, “The vow we take is the Hippocratic oath—not the hypocritical one.”

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring watch the above video. This is just an approximation of the audio contributed by Jonathan Hodgson.

Belief in the words of the doctor “you are going to get better” is a powerful part of treatment and cure. People with hope (such as cancer patients) often survive the odds when they believe they are going to get better. Doctors who use placebo know and understand that their words and treatment can affect the outlook of the patient. And that positive outlook on the patients part is powerful in the healing process.

http://www.facebook.com/patrick.asselin.16 Patrick Asselin

I really liked that last line, that was good. It made me think, if a doc doesn’t have a definitive diagnosis, why not suggest alternative methods, e.g. chiropractic, accupuncture. Inform the pt. let the pt. decide. Thanks for all you do Doc.

beccadoggie10

My new physician prescribed recombinant DNA Boniva, a bisphosphonate once a month pharmaceutical. After looking at the side effects at the National Library of Medicine (TOXNET/HSDB), and based on what I’ve learned about GMO foods, I want nothing to do with it. GMO drugs may help, but they also may be a lie, alike GMO crops. And, I don’t want to be in any more pain than I already am in with no way to reduce the pain for the rest of my life, plus have a rotten jaw and still fracture bones other than the spine.

I do not trust the U.S. FDA, which puts biologic recombinant DNA drugs (and foods) on the market, but does not require peer reviewed safety testing for human beings and does not necessary follow up and remove the drug when the added side effects cause death.

I believe in myself. Not all treatments that I’ve had over the years to have worked, where non-gmo remedies that were not pharmaceuticals have worked. Now I worry with all the new GMO’s going into herbal medicinals, if I can treat myself with remedies recommended by naturopath physicians.

jah

You are wise to refuse Boniva. I took one pill, one time, two years ago, and am still having problems as a result, and fear permanent damage to my esophagus, stomach and intestinal system. It felt like I had swallowed battery acid or Draino. Since then, I have constant heartburn and other digestive problems. What is especially sad is that I asked the doctor beforehand if there were the possibility of side effects, and she assured me I wouldn’t have a problem. Now, I will never trust what a doctor says again,and will never take a pharmaceutical without doing my own research…

beccadoggie10

When many physicians insisted that I have a Corticosteroid injection for every time a part of my body was inflamed due to injury, and I trusted what they said, only to find that it seemed to alter my immune system, I began to research myself of the side effects.

I have since learned through the National Library of Medicine that corticosteroid injections increase the risk of osteoporosis in the body.

Whether it was due to those injections, or my age and refusal to ingest Premarin and other hormone replacement therapies to prevent osteoporosis that were linked to cancer, I don’t know.

But, I do know that many physicians peddle drugs, after all, that’s how medical schools train them. I feel that we, the patient, must learn all that we can about a drug prior to ingesting them…perhaps, even before filling a prescription in the first place. Although, I must say from experience, that some physicians will not let you return if you doubt their treatment. And, yet, perhaps a second or third opinion is better anyway, as long as they don’t go to the same medical school.

Most genetically modified foods also give the same symptoms, either from the process of changing the DNA itself, or from the herbicide they are created to resist. For example, glyphosate (Roundup) when intentionally ingested in Taiwan. The abstract of the study said:

“Intentional ingestion (80 cases) resulted in erosion of the gastrointestinal tract (66%), seen as sore throat (43%), dysphagia [difficulty swallowing] (31%), and gastrointestinal haemorrhage (8%). Other organs were affected less often (non-specific leucocytosis [ frequently a sign of an inflammatory response] 65%, lung 23%, liver 19%, cardiovascular 18%, kidney 14%, and CNS 12%). There were seven deaths, all of which occurred within hours of ingestion, two before the patient arrived at the hospital. Deaths following ingestion of ‘Roundup’ alone were due to a syndrome that involved hypotension, unresponsive to intravenous fluids or vasopressor drugs, and sometimes pulmonary oedema, in the presence of normal central venous pressure.”

When I Googled the symptoms of GERD (gastrointestinal reflux disease) the symptoms looked similar. However, I am NOT medically trained. But I do know that clinical effects of pesticides mimic those of other diseases, because I have been poisoned with an insecticide and as well as solvents in a chemical floor stripper, and one of the chemicals in common was mixed xylene isomers, known because it was labeled.

http://www.facebook.com/darryl.roy.752 Darryl Roy

Boniva is produced by conventional chemical synthesis, not by recombinant bacteria (DIYers can look at US patent 8178712). No GMOs are involved.

The Recognition and Management of Pesticide Poisonings, a U.S. EPA handbook, tells doctors to treat the symptoms of pesticide poisoning, not to treat the disease. But, even treatments can and are often more toxic to the patient than the prevention of not coming in contact with the pesticides themselves. And, not all pesticides (which include herbicides “weed”, insecticides, bacteriacides, fungicides, rodenticides, etc.) have antidotes. Most, do not.

The book also says that most doctors don’t know how to diagnose the problem, because they don’t ask the correct questions. I found this true the first time I was exposed to a flea fogger, which caused me to cough up blood for over a year, and contributed to cognitive damage and memory loss afterwards.

Even taking the product with me to the physician did not help. Medical schools do not train physicians to diagnose and treat chemical poisoning because they are state schools, dependent upon funding to the very industries that poison for profit.

NYVegan

In the context of this article, there are two broad classes of patients: (1) Those who blindly accept their doctor’s advice and prescribed medications, and (2) those who research the diagnosis and prescription themselves after leaving the doctor’s office. The latter group is becoming much larger with the advent of the internet. A patient who finds she’s been deceived may not gain the power of positive thinking, and the doctor may lose the patient’s trust and business.

Coacervate

This is a mental health issue that goes right to the core of the social fabric. We can continue to dance around it with various gimicks such as placebo, gun control laws, drug wars and lotto OR face up to reality. As long as we allow depression, anxiety, panic disorder and so on to remain “hidden” in stigma the consequences on our individual and collective social health will continue to devastate. In short, we need to educate people and put the proper value on happiness (cf. Bhutan happiness laws). We need to provide positive services to those who need it, not simply declare them cured and turn them out on the street.

The results presented here may be valid but the conclusion, that to lie is better is a complete miss. Sometimes you just have to listen to the data and see the big picture.

beccadoggie10

Did you know that Glyphosate, the herbicide (i.e. Roundup), has been strongly linked to not only inflammatory diseases, but to “depression” and other psychosomatic disorders?

John

I can vouch for that after switching over to the plant-based diet and losing over 110 pounds in 11 months. the doctor closed the door behind him and later told me that this office was a candy shop and told me that never wanted to see me again after I questioned him! Haha #plant-power

Cardwell

Question- when you switched over did you have a problem with a huge craving for carbs and sweets? I’m trying to switch to a plant based diet but I’ve started craving cakes and pies like a drug addict craves heroin. What is happening and what can I do to turn it around?

lgking

I still go through the same cravings from time to time. For me, the name of the game is ‘substitution’. When I crave filling/fatty sweets, I eat a small bowl of raisens and pumkin seeds. I fill up on that and it does the trick. Other nuts and dried fruits will work just as well.

beccadoggie10

I switched to reduce the pain and inflammation in my body after fracturing my spine and not wanting drugs.

My biggest cravings have been Swiss cheese and yogurt. Soy foods do not make it for me. I don’t miss sugar. But, do occasionally put certified organic dried pineapple in my green tea if I brew it too strongly.

After trying an occasional piece of craved food, which is not on my diet, and experiencing severe pain within 12 hours, I’m cured for another several months. Maybe someday that will go away. I am learning how toxic meat, inc. fish, and dairy protein are because of how toxic our environment has become due to pesticides and herbicide resistant crops. Now I know why my nervous system is SCREAMING when I eat the wrong food.

There is nothing like pain to set me on the straight and narrow.

Lizzie

Just another reason to avoid doctors. (Not YOU, Dr. Greger : ))

beccadoggie10

Doctors who know no nutrition, generally do not know about natural anti-inflammatory compounds, including turmeric, ginger, garlic and boswellia, which may work as well as aspirin and ibuprofen for treating osteoarthritis.

Of course, if you are on drug thinners, you must take caution and consult with your physician. But, I pride myself in not taking drugs. And choose to use these natural remedies instead.

But, we may soon lose these natural remedies as Monsanto has put medicinal herb seed companies out of business and is planning to change the DNA of most if not all items found in health food stores or prescribed by naturopaths very soon. Already the biotechnology companies have had the International Agency for the Research on Cancer test aloe vera and other herbs for the ability to cause cancer. It is my strong suspicion that they will take those results and write them into their patented GMO remedies saying there is “no substantial evidence” that the new medicinal is any different than any other and all the tests they claim but do not do.

I appreciate everything that Dr. Greger has done to inform us. He, alike Andrew Weil, Neal Barnard, and a handful of other physicians I trust. Unfortunately, none of them are where I live.

RM

RM

http://www.facebook.com/darryl.roy.752 Darryl Roy

One problem with medical trials is that patients often “break blind” by noticing side-effects of a drug, thus knowing they’re not in the placebo arm. This can seriously confound results, and especially in trials for psychiatric drugs. One counter to this is to use an active placebo, which has side-effects, but no known theraputic effects on the disorder being treated.

For example, in Moncrieff, J. et al. “Active placebos versus antidepressants for depression.” Cochrane Database Syst Rev 1 (2004), http://www.update-software.com/BCP/WileyPDF/EN/CD003012.pdf the meta-analysis looked at 9 trials of 1st generation tricyclic antidepressants vs the active placebo atropine, which produces similar side effects but has no effect on brain serotonin. The theraputic effect of the antidepressants vs. active placebo wasn’t significant in 7 of the 9 trials.

The current generation of SSRI antidepressants are safer, but not more effective than the tricyclics. They exhibit similar trial behavior, where inactive placebos have about 75% of their effect, leaving just 25% to any drug response. It’s little wonder that the use of active placebos has fallen out of favor in antidepressant trials submitted to the FDA.

http://twitter.com/kenleebow N=1

Before it was “in vogue”, my father-in-law, a psychologist, advised me that placebos were very effective. And currently, I’m in a 5-year clinical study with Vitamin D and Omega-3 … don’t know if I’m taking the real thing or the placebo … but I feel great!

http://www.facebook.com/darryl.roy.752 Darryl Roy

Best username ever.

Kal

One thing that went unstated was that placebos and predictably ineffective treatments doled out by baffled doctors can prevent people from obtaining effective treatment elsewhere.

[Rant]

From when I learned to speak until the age of 19 I had near constant gut pain. I had several doctors give me many pills with confident assurances that I would get better. In retrospect most of those pills were nearly identical to, or different names for, previous ineffective treatments. It wasnt until I was put in substantial danger by a drug combination that I fired my doctor and decided to cure myself. In the end my constant painful intestinal inflammation was cured in a week by eliminating chocolate, processed meat, and eggs from my diet. I had been raised on a junk food diet. I’ve been 100% cured for 14 years now. Thankfully I didnt get cancer, liver failure, or permanent neurological damage from the pseudo-placebo antics of seemingly confident physicians. [/Rant]

Plantstrongdoc

Every knowledgeable doctor knows that the relation (between doctor and patient) cures. Sometimes with drugs, sometimes without. Of course you can tell a patient, that you haven`t got a clue what is wrong (but it is not dangerous – because if it was dangerous you would recognize the symptoms), and if you have a good relation with the patient (and the patient has faith in you), the symptoms will disappear – without sugarpills.

LouisTR

Hi Dr. Gregger, I got a question for you. I read a lot of times that calcium hinders iron absorption, but Dr. Jack Norris thinks calcium we get in food doesn’t (contrary to supplements). Would you give me your opinion on that issue? And what about foods high in both calcium and iron like sesame or tofu? Thank you very much!

LouisTR

Oups, Greger*, sorry!

http://www.facebook.com/jmerrikin Jim Merrikin

Soooo, when these people go to their pharmacies to pick up their “placebo” prescription, are they:

1.) from the same manufacturer of the original drug? 2.) charged the same amount or copay as the real drug?

I want to believe that it might be possible to determine if a prescription is a placebo somehow, by looking up the code/photo or something else.

Frank

Well done, Dr. Greger! Since we don’t know very much about healing, and since there is so much trauma induced in us that conventional medicine cannot address, the ‘let’s help’ no matter what is wonderful. No idea is more important than human suffering. The ‘truth’ is just a fictional idea.

Very best regards, Frank

http://twitter.com/christieison Christie Morgan Ison

This makes me crazy. There are so many disease states that present with nonspecific symptoms. Maybe the trend of doctors lying is simply because it’s too expensive to test further, and there is risk of insurance not covering. I went through this personally, with fatigue and pain so extreme that I was mostly bedridden some years ago.

To my knowledge, I never had a doctor use placebo, but I had several try things that were within their own specialty. My GP prescribed antidepressants (I wasn’t depressed); the sleep specialist diagnosed me with narcolepsy (while admitting at the same time I didn’t fit any of the profiles and didn’t have the genetic marker) and prescribed harsh stimulants.

It turns out, years later, that the whole thing was a food-related intolerance that was easily resolved with diet changes. But, if we had never found this, my life would have been ruined by now. I urge doctors to think twice before judging pesky patients as “crazy” or “attention-seeking.” We just might be really, really sick.

beccadoggie10

The same symptoms that many pharmaceuticals seem to cause, are also caused by the chemicals used to manufacture pesticides. After all, it has been the same industry! The petrochemical industry.

I don’t have a background in chemistry or medicine, but after being accidentally poisoned with an insecticidal fogger and years later with volatile organic compounds in a floor stripper, and experiencing a whole range of symptoms which could be attributed to anemia and other diseases, but physicians not confirming the problem (despite my having the container in both cases), I was told it was psychosomatic..

My fingers are still numb from when the floor stripper penetrated my gloves but was told I had high cholesterol. My cholesterol is in the normal range now, but the numbness, pins and needles sensation continues.

And yes, I was told I was “crazy” or “attention-seeking” and my husband believed them. Receiving a computer and then searching the internet, I learned that what I felt was NOT in my mind other than affecting my brain, and peripheral nervous system.

Eating certified organic foods and a change in diet, which I found helped me reduce pain and inflammation, helped save my life. But, that was from my constant research and NOT from the local medical community who are drug pushers.

Sven

Have you guys heard of (read) Bruce Lipton’s work? (Biology of Belief)

It’s reasonable to explain the placebo effect to patients, and it’s reasonable to teach strategies designed to achieve a positive outlook. But I, for one, won’t ever return to a doctor who knowingly cons me.

Sven Andres

I think the placebo effect would no longer work if you knew that it is a placebo. I think the whole point is that you are convinced it is not, that it is the “real thing” and that it will make you better. (-:

In other words, the very act of con-ing you is what does it.

Positive outlook and (positive) believing are different things, I think. Positive outlook is saying (or superficially thinking) “I’m going to get better by thinking positively”, but deep down you’re thinking “Yeah, right!” (-:

Thea

I’m completely torn about this.

On one hand, I fully believe in, “Do what helps.” And I think this video provides great support for the idea that a placebo can help when a doctor is feeling helpless and doesn’t know what else to do.

On the other hand, I am one of those people who does not like to be lied to. Knowing that doctors do this, makes me less likely to trust or believe a doctor even when he/she is telling me the truth. That lack of trust could easily turn a future situation for me (and others like me) negative when it didn’t have to to be that way.

I do think a potential happy compromise might be what Dr. Greger discussed near the end. Though I think it should go down like this: Dr. says, “I don’t know what is causing your problem.” (or “I believe I have the right diagnosis, but Western medicine does not have a reliable cure.”) “However, I have seen some good results with similar cases to yours by trying this ___ alternative idea. There are no guarantees, but I can work with you on implementing this to avoid side effects and if this doesn’t work, we will keep looking until we find something that does work. …” If a doctor took that approach with me, the trust would still be intact and I would be very happy and would respect the doctor a great deal more than a doctor who just proscribed a sugar pill.

HereHere

I went to an MD a year or two ago for a leg that was so stiff from an exercise I did with a personal trainer, I couldn’t walk on it. I hobbled in the office, he prescribed an anti-inflammatory, and I asked him if there was a natural alternative. He said sure, pineapple or papaya, but to take the naproxen anyway – and to use a cane. For an MD to prescribe food impressed me, but to this day, I think he did so as a placebo. I can think of a variety of other anti-inflammatory foods, and I don’t think pineapple is top of the list. But I did buy both fruits. I took 2-3 over-the-counter doses of naproxen (half of what was prescribed) and I was walking like normal within a day or two. Perhaps instead of prescribing fruit as a placebo, every MD should prescribe fruits and veggies every time patients come in, since about 90% of the population do not get adequate amounts.

beccadoggie10

I would eat the pineapple and papaya first (assuming they were not genetically engineered –nearly all Hawaiian papaya and some of Florida’s papaya contain GMO’s). However, after reading the side effects of naproxen (and I think you smart for taking half of what was prescribed!), I would look for alternatives like natural anti-inflammation remedies. Roots of ginger, garlic, and turmeric (not yet GMO) do a wonderful job of reducing pain and inflammation in the body.

And prior to biotechnology being released into the marketplace in both pharmaceuticals and foods, papaya and pineapple had substances that did the same in reducing pain and inflammation.

When googling naproxen, I learned that it is associated with recombinant DNA (genetic engineering). Some of these genetic engineering drugs may work, but the side effects are horrendous. I would not say anything to the doctor, but take a copy of his prescription, and then personally research the drug before ingesting it.

I also

Monica Dewart

I certainly hope that no doctor has ever lied to me. It would undermine my trust in their profession.

JS Baker

Dr. Gregor,

This is off the topic of placebos but I can’t see where else to submit a general comment or question, so here it is:

And thank you for the amazing work you do and the education you offer everyone through your website. I’ve been reading you and your knowledgeable subscribers for the past 6 months and have given up all animal products as a result, after 58 years of what I believed was healthy eating.

Best regards, Jeff

Thea

re: “I’ve been reading you … and have given up all animal products as a result, after 58 years of what I believed was healthy eating.”

Wow. That’s awesome. Good for you for taking your health into your own hands!

Kathleen Graas

I definitely do NOT want to be lied to by my doctor and if I even find out she did it, she would no longer be my doctor. In future, I will remember to ask if a doctor feels it is okay to lie to a patient, BEFORE I take them on as my provider.

Jen

We are such fans of this site and have passed it on to many, many patients, fellow physicians, family members and friends. That said, my husband and I are quite skeptical and disappointed with this “review blog and video” and feel it is truly misleading and out of touch with the reality of medical practice. We have been in medical practice for almost 30 years and have never worked in a hospital that even offers “placebo pills” from the pharmacy, nor do we know one health practitioner that has ever prescribed placebo/ sugar pills. Whatever one’s view is on whether or not lying to patients and treating them with sugar pills is ethical or not, it is against hospital policies, is a set up for litigation, and is not even available to physicians from hospital pharmacies. Use of placebo/ sugar pills may be used by some physicians in an academic setting if they are conducting clinical research, perhaps on mind/body medicine, but this is NOT something used in medical practices, and not something hospital administrators would be willing to risk litigation for. This video leads one to believe prescribing sugar pills is a common practice, which is absolutely false in a typical clinical setting, and quite frankly almost unheard of. Disappointed!

Next Video

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